HEALTHCARE RESOURCE UTILIZATION AND COSTS OF DIABETES MELLITUS: A RETROSPECTIVE REAL-WORLD COST-OF-ILLNESS ANALYSIS IN BRAZIL
Author(s)
JULIANA BUSCH, MD1, Joao Paulo Dos Reis Neto, PhD, MD2;
1CAPESESP, Director, Rio de Janeiro, Brazil, 2Diretor-Presidente da Capesesp, Rio de Janeiro, Brazil
1CAPESESP, Director, Rio de Janeiro, Brazil, 2Diretor-Presidente da Capesesp, Rio de Janeiro, Brazil
OBJECTIVES: To evaluate healthcare resource utilization and associated costs among beneficiaries with Diabetes Mellitus (DM) in a self-managed health plan, examining the relationship between comorbidities, diabetes-related complications, and financial impact, assessing if appropriate glycemic monitoring may help reduce costs.
METHODS: A retrospective, longitudinal observational cohort study was conducted using administrative claims data from a Brazilian self-managed health plan between January/ 2019 and December/2024. Beneficiaries with a diagnosis of DM (ICD-10 E10-E14) and at least 12 months of continuous enrollment were included. Demographic characteristics, healthcare utilization (outpatient visits, diagnostic tests, emergency department visits, therapies, hospitalizations, and length of stay), total and category-specific costs, comorbidities (Charlson Comorbidity Index [CCI]), and microvascular and macrovascular complications were analyzed. Patients were stratified into cost tiers based on annual individual expenditures. Multivariate logistic regression identified factors associated with high-cost status.
RESULTS: Among 46,427 beneficiaries, 694 (1.5%) had DM, with a mean age of 73 years and female predominance (54.5%). More than 60% had at least one comorbidity (CCI ≥1), and 52.4% presented diabetes-related chronic complications, most frequently retinopathy (20.9%), myocardial infarction (18.9%), and stroke (18.7%). The mean annual cost per patient was US$ 12,456, totaling US$ 20,252 million over the study period. Hospitalizations accounted for 74% of total expenditure. Higher cost tiers were strongly associated with increased hospitalization rates, longer hospital stays, and a higher burden of comorbidities. Hospitalization increased the likelihood of high-cost classification more than three times (OR 3.3), while HbA1c monitoring was associated with a reduced risk of high-cost status.
CONCLUSIONS: In patients with DM, poor glycemic control, associated with multiple comorbidities and complications, healthcare costs substantially increase driven largely by hospitalizations. Proactive strategies focused on monitoring, prevention, and coordinated care may enhance clinical outcomes reducing the financial burden of DM and contribute to the financial sustainability of health plans.
METHODS: A retrospective, longitudinal observational cohort study was conducted using administrative claims data from a Brazilian self-managed health plan between January/ 2019 and December/2024. Beneficiaries with a diagnosis of DM (ICD-10 E10-E14) and at least 12 months of continuous enrollment were included. Demographic characteristics, healthcare utilization (outpatient visits, diagnostic tests, emergency department visits, therapies, hospitalizations, and length of stay), total and category-specific costs, comorbidities (Charlson Comorbidity Index [CCI]), and microvascular and macrovascular complications were analyzed. Patients were stratified into cost tiers based on annual individual expenditures. Multivariate logistic regression identified factors associated with high-cost status.
RESULTS: Among 46,427 beneficiaries, 694 (1.5%) had DM, with a mean age of 73 years and female predominance (54.5%). More than 60% had at least one comorbidity (CCI ≥1), and 52.4% presented diabetes-related chronic complications, most frequently retinopathy (20.9%), myocardial infarction (18.9%), and stroke (18.7%). The mean annual cost per patient was US$ 12,456, totaling US$ 20,252 million over the study period. Hospitalizations accounted for 74% of total expenditure. Higher cost tiers were strongly associated with increased hospitalization rates, longer hospital stays, and a higher burden of comorbidities. Hospitalization increased the likelihood of high-cost classification more than three times (OR 3.3), while HbA1c monitoring was associated with a reduced risk of high-cost status.
CONCLUSIONS: In patients with DM, poor glycemic control, associated with multiple comorbidities and complications, healthcare costs substantially increase driven largely by hospitalizations. Proactive strategies focused on monitoring, prevention, and coordinated care may enhance clinical outcomes reducing the financial burden of DM and contribute to the financial sustainability of health plans.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
RWD146
Topic
Real World Data & Information Systems
Topic Subcategory
Health & Insurance Records Systems
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity)